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Over the past decade there has been increasing interest in the psychiatric aspects of maintenance hemodialysis. In this presentation I shall review the problems in psychosocial adaptation to this treatment modality, emphasizing patient response but touching upon the reactions of those involved in the care of the patient with end-stage renal failure.

Summary Principal components analyses of the intercorrelations among age, education, self-concepts, manifest psychopathology, cognitive measures of human distance, and various indices from Kuethe's felt figure techniques were reported for 48 schizophrenic and 30 normal women. The felt figure indices for both groups represented components corresponding primarily to their techniques of measurement. The few independent relationships between the felt figure indices and other variables indicated that Kuethe's techniques may measure different dimensions in normal and schizophrenic women.

The experiences over the past 5 years of developing and working in Boerum Hill, a 260-bed psychiatric halfway house, provide the basis for this presentation. The paper addresses itself to a definition and discussion of psychiatric rehabilitation and notes the significance of temporariness of stay in a halfway house. The method of the establishment of a proper therapeutic community environment that will bring about a corrective living experience is described. Also, aspects of the significance of the physical plant, the size of the residence, the role of psychotropic medication, and the management and staff attitudes toward regression are discussed. Finally, the psychodynamics of personality change and the importance of high expectations in the rehabilitation effort are presented.

Summary A group of 27 male subjects were administered the Rorschach at ages 14 and 24. The protocols were scored for the main categories of the Holt Primary Process scoring system. A comparison of the two age groups indicates that at age 24 there is a decrease in the percentage of primary process responses and an increase in “adaptive regression.” Individual differences for all the primary process scoring categories remained highly consistent for the 10-year period spanned by the data. Adaptive regression was found to be significantly correlated with IQ, field independence (RFT), and Rorschach ratings of intellectualization at both ages. The results were viewed as suggesting that primary process manifestations on the Rorschach seem to be mediated by stable aspects of an individual's cognitive abilities and cognitive style.

The experience of becoming and having a sibling is a common situation for many preschool children. In order to clarify the implications of such an event for the older preschool child, the authors have surveyed the literature and interviewed a series of fami- lies where there was a second or third birth. This is a preliminary communication where a broad overview of the many variables in- volved is sought. Varied techniques for preparing the older preschool sibling were observed, as were varied coping mechanisms employed by the older child in adjusting to the change in his family status. Fourteen variables are discussed, and suggestions are made for fur- ther research.

A personal account of an autohypnotic experience is presented. The theoretical concept of hypnosis as a potentially adaptive regression is related to the content of the report and elaborated in an ego-psychological context.

The thesis is proposed that the relative effects of social deprivation may be useful in understanding psychological, etiological factors in “mental retardation.” Social deprivation, a relative construct, is viewed as resulting from the difference between predeprived and deprived levels of adult social stimulation, and as being greatly affected by the rate of change. A case history approach is used to illustrate how the relative social deprivation thesis can contribute to a better understanding of the child's emotional and intellectual development and to the understanding of treatment techniques.

Psychological state measures were obtained on over two thousand junior high school students. Half of the students were tested relatively early in the day and the other half late in the day. Results indicated that self-reported measures of anxiety, stress, regression and depression tended to be higher for the group tested near the end of the school day than for those tested early in the day. A major methodological implication is that we should have separate norms for ‘time of day’ when we are dealing with state measures.

This study of coping strategies reports on interviews with 19 survivors of Nazi concentration camps. The subjects, relatively healthy survivors who were not severely psychiatrically disabled, were interviewed in Jerusalem and the San Francisco Bay area. The author presents a classification of coping strategies in extreme stress situations and discusses the long-term effectiveness of certain of these strategies.

Recent work at the Wisconsin Primate Laboratory has been directed toward experimental production and cure of human-type psychopathologies in rhesus monkey subjects. A primary emphasis has been on depression. Data are presented which identify different procedures designed to produce depression, help determine the susceptibility of any given subject to such procedures, and which outline methods and modes of therapy. The significance and future of work in the area of monkey models of human disorders is discussed.

As the family child-rearing life cycle unfolds, puberty sets in motion processes within the adolescent and the family that initiate an adolescent family developmental epicycle. An integral aspect of this epicycle is a temporary regression in sibling, marital, and family functioning, reflecting a creative return to earlier modes of experience and behavior. This normal regression provides the empathetic interpersonal framework within which family members get in touch with, share, and facilitate adolescent development—while at the same time growing themselves as individuals and as a family unit.

The development of psychologically healthy means for coping with sexuality is particularly difficult for disturbed adolescents who need residential treatment. One of the clearly definable psychodynamic constellations that underlie sexual acting-out—an abortive mourning process in response to separations or losses suffered by female adolescent inpatients—is discussed. John Bowlby's theory of the mourning process is emphasized in understanding the immediate reaction to loss. Case material is presented in support of the hypothesis that with some disturbed female adolescents, heterosexual acting-out wards off a regressive wish, kindled by object loss, to reunite symbiotically with the preoedipal mother. Suggestions are given for milieu management and psychotherapy in such cases.

(1974). Issues in the Analysis of a Preschool Girl. The Psychoanalytic Study of the Child: Vol. 29, No. 1, pp. 319-340.

The authors describe a modification of systematic desensitization that they developed which uses a psychodynamic formulation as the basis for treatment along behavioral lines. The technique, illustrated by the authors through case reports, involves efforts to relieve the patient's anxiety arising in connection with unacceptable impulses or with irrational prohibitions against these impulses.

This topic would have been too ambitious, had it not been the subject of the congress: ‘what is psychotherapy?’ Our contribution will be merely a basis for discussing and summarizing the experiences o

This paper suggests a relationship between the enforced passivity of confinement and certain peculiarities of behavior seen among both hospitalized patients and other incarcerated groups such as prisoners. It is proposed that confinement has deleterious effects on certain ego functions. Finally, it is recommended that steps may be taken, based upon a knowledge of the psychological issues involved, which may lessen regression during confinement and facilitate return to normal mental functioning upon release from confinement. Clinical material illustrating effects of confinement is drawn from the author's experiences as a psychiatrist in the federal prisons and juvenile courts and from observations of patients hospitalized for physical and mental disorders.

SYSNOPSISOn the Aubert illusion, involving judgement of visual vertical in the absence of visual field cues, depressed patients were shown to display regressive tendencies compared with controls. In fact, their performance was very similar to that of children. However, their performance at judging postural vertical without the use of visual field cues was normal. The impaired performance of the depressed patients was compared with the deficits observed on the same experimental tasks for various other groups of patients with psychiatric or neurological disorders.

(1974). Adaptive and Maladaptive Regression in Hemodialysis. Psychiatry: Vol. 37, No. 1, pp. 68-77.

The author discusses the correlative nature of projection and introjection, their early roles in development and differentiation, and their later defensive uses. He describes how, in paranoid states, the interplay between projecting and introjecting leads to conflicted ambivalence between preserving and annihilating significant objects.

In this paper, reports of earlier attempts to rate ego functions are reviewed, and a detailed account of a current selection of 12 ego functions from the psychoanalytic literature is presented. Component factors of each function are delineated and examples are provided of how these functions are mea

2 extreme MMPI social introverts and 2 extroverts were hypnotically regressed to a prior existence and their descriptions of that existence were tape recorded. Later, judges rated each taped segment on 32 semantic differential scales. Personality had a marked effect on the quality of the hypnotic fantasies. Fantasies of introverts were judged to be passive, impotent, and negative in evaluation. Extroverts' fantasies were judged the exact opposite. Implications of these findings were discussed.

We bring to old age a built-in system of self-depreciation, having thoroughly absorbed the notion that the elderly are unattractive, useless and meddlesome. The oldster's struggle to adapt and adjust to this hostile environment can give rise to various symptoms. A common example is memory failure.

(1968). Smiling in Schizophrenia. The Psychoanalytic Quarterly: Vol. 37, No. 1, pp. 103-113.

Summary Spontaneous closure of relatively large membranous ventricular septal defects was observed as accessory finding in five cases during routine autopsies. The defects were closed completely by adherence of the leaflets of the tricuspid valve to the edges of the defect in four cases and only partially in one. The adherence of the leaflets was initiated by endocarditis or—more likely—by turbulence fibrosis; this process, however did not impair the function of the tricuspid valve in any of the cases, thus resulting in complete recovery from a serious disease. During autopsies of infants with ventricular septal defects one can observe on a number of occasions septal leaflets or chordae of the tricuspid valve adherent to the edges of the defect, thereby decreasing its size. Although spontaneous closure is not rare, surgical intervention must not be delayed, if a ventricular septal defect is accompanied by severe symptoms.

With sociometric and staff rating data from a sample of 33 female adolescent in-patients on a psychiatric ward, two general hypotheses regarding leadership were tested based on prior results for “normal” populations. The first hypothesis stated that leader roles in the present collectivity would be clearly differentiated in terms of an instrumental versus expressive dimension and also a reputed versus actual dimension. The results did not confirm this, showing instead significant and strong intercorrelations among the several sociometric measures of leadership roles. The second hypothesis stated that leaders in the present sort of collectivity would tend to be higher in age and other traits socially desirable in the society at large. This hypothesis was confirmed, indicating a substantial similarity between the nature of leadership in a psychiatrically deviant collectivity and the nature of leadership in numerous other “normal” collectivities. A major departure from prior results in “normal” collectivities was the fact that ratings of asocial aggression were independent of leadership nominations, interpreted as indicating a high tolerance for “interpersonal deviance” in this psychiatrically deviant collectivity.

A “preoccupation” hypothesis of schizophrenic deficit was proposed and a psychomotor approach to treatment (Simulated Work Therapy) was tested. Results of this first study indicated that the treatment, through intensive interference with preoccupation, increased 12 chronic schizophrenics' responsiveness to hospital routines and reduced their irritability.

A therapeutic technique to facilitate hypnotic recall is described. The recall of events surrounding the patient's birth appears to be particularly significant. During therapeutic sessions with patients, these events are portrayed as causative factors in the patient's illness and are relived with great affect. After such sessions, relief of relevant symptoms often follows. Two cases are presented which allowed for verification of details mentioned by the patients during such regressions. While rigorous evidence is lacking, it is the author's view that these experiences represent real memories; however, the possibility that they are therapeutically useful fantasies cannot be disproven at this time.

The psychodynamic pattern of acquiring psychotherapy skills can be viewed as one that exhibits regressive periods which tend towards one of two poles, ‘moving towards’, and ‘distancing’. A major block to learning, especially the learning of individual psychotherapy, is the resident's difficulties in the area of self-awareness. Pointing out psychodynamic patterns to him is essential, both to make him cognizant of the existence of the unconscious in the fullest sense and to allow the learning process to progress, possibly in a more adaptive way. Individual psychotherapy supervision is a major vehicle for such learning. Some guidelines for psychotherapy supervision are presented.